Provider Demographics
NPI:1730411273
Name:JORGENSEN, LAUREN LEE (DC)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:LEE
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:LEE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:100 S DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-1208
Mailing Address - Country:US
Mailing Address - Phone:724-662-4299
Mailing Address - Fax:724-662-5800
Practice Address - Street 1:100 S DIAMOND ST
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-1208
Practice Address - Country:US
Practice Address - Phone:724-662-4299
Practice Address - Fax:724-662-5800
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025634940001Medicaid